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Objective To create risk predictive models of healthcare-seeking delay among imported malaria patients in Jiangsu Province based on machine learning algorithms, so as to provide insights into early identification of imported malaria cases in Jiangsu Province. Methods Case investigation, first symptoms and time of initial diagnosis of imported malaria patients in Jiangsu Province in 2019 were captured from Infectious Disease Report Information Management System and Parasitic Disease Prevention and Control Information Management System of Chinese Center for Disease Control and Prevention. The risk predictive models of healthcare-seeking delay among imported malaria patients were created with the back propagation (BP) neural network model, logistic regression model, random forest model and Bayesian model using thirteen factors as independent variables, including occupation, species of malaria parasite, main clinical manifestations, presence of complications, severity of disease, age, duration of residing abroad, frequency of malaria parasite infections abroad, incubation period, level of institution at initial diagnosis, country of origin, number of individuals travelling with patients and way to go abroad, and time of healthcare-seeking delay as a dependent variable. Logistic regression model was visualized using a nomogram, and the nomogram was evaluated using calibration curves. In addition, the efficiency of the four models for prediction of risk of healthcare-seeking delay among imported malaria patients was evaluated using the area under curve (AUC) of receiver operating characteristic curve (ROC). The importance of each characteristic was quantified and attributed by using SHAP to examine the positive and negative effects of the value of each characteristic on the predictive efficiency. Results A total of 244 imported malaria patients were enrolled, including 100 cases (40.98%) with the duration from onset of first symptoms to time of initial diagnosis that exceeded 24 hours. Logistic regression analysis identified a history of malaria parasite infection [odds ratio (OR) = 3.075, 95% confidential interval (CI): (1.597, 5.923)], long incubation period [OR = 1.010, 95% CI: (1.001, 1.018)] and seeking healthcare in provincial or municipal medical facilities [OR = 12.550, 95% CI: (1.158, 135.963)] as risk factors for delay in seeking healthcare among imported malaria cases. BP neural network modeling showed that duration of residing abroad, incubation period and age posed great impacts on delay in healthcare-seek among imported malaria patients. Random forest modeling showed that the top five factors with the greatest impact on healthcare-seeking delay included main clinical manifestations, the way to go abroad, incubation period, duration of residing abroad and age among imported malaria patients, and Bayesian modeling revealed that the top five factors affecting healthcare-seeking delay among imported malaria patients included level of institutions at initial diagnosis, age, country of origin, history of malaria parasite infection and individuals travelling with imported malaria patients. ROC curve analysis showed higher overall performance of the BP neural network model and the logistic regression model for prediction of the risk of healthcare-seeking delay among imported malaria patients (Z = 2.700 to 4.641, all P values < 0.01), with no statistically significant difference in the AUC among four models (Z = 1.209, P > 0.05). The sensitivity (71.00%) and Youden index (43.92%) of the logistic regression model was higher than those of the BP neural network (63.00% and 36.61%, respectively), and the specificity of the BP neural network model (73.61%) was higher than that of the logistic regression model (72.92%). Conclusions Imported malaria cases with long duration of residing abroad, a history of malaria parasite infection, long incubation period, advanced age and seeking healthcare in provincial or municipal medical institutions have a high likelihood of delay in healthcare-seeking in Jiangsu Province. The models created based on the logistic regression and BP neural network show a high efficiency for prediction of the risk of healthcare-seeking among imported malaria patients in Jiangsu Province, which may provide insights into health management of imported malaria patients.
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Objective:To investigate the clinical effect of long head of biceps tendon (LHBT) insertion reconstruction combined with pulley repair for pulley system injuries.Methods:A total of 46 patients (combined treatment group) with pulley system injury treated with LHBT insertion reconstruction combined with pulley repair in the Sports Medicine Department, Affiliated Xinhua Hospital of Dalian University from January to December 2020 were retrospectively analyzed, including 16 males and 30 females, aged 51.3±5.7 years (range, 45-72 years). 46 patients who underwent simple LHBT insertion reconstruction during the same period were selected as the control group (simple reconstruction group), including 14 males and 32 females, aged 50.6±6.7 years (range, 46-70 years). Visual analogue scale (VAS), Constant-Murley score, American Shoulder and Elbow Surgeon (ASES) score and long head of biceps tendon (LHB) score were compared preoperatively and at 1, 3, 6, 12 and 24 months postoperatively.Results:All patients were followed up for 26.2±1.5 months (range, 24-27 months). The VAS scores of the combined treatment group at 1, 3, and 6 months postoperatively were 3.4±1.3, 2.0±1.1, and 1.7±0.5, respectively, which were significantly lower than those of the simple reconstruction group 5.8±1.3, 3.5±1.1, and 2.6±0.5 ( P<0.05), while there was no significant difference between the two groups at 12 and 24 months postoperatively ( P>0.05). The Constant-Murley scores of the combined treatment group at 1, 3, and 6 months postoperatively were 31.3±4.7, 72.8±4.6, and 89.1±5.4, respectively, which were statistically greater than those of the simple reconstruction group (21.5±6.8, 52.8±5.2, and 80.1±6.2), and the differences were statistically significant ( P<0.05), while there was no statistically significant difference between the two groups at 12 and 24 months postoperatively ( P>0.05). The ASES scores of the combined treatment group at 1 and 3 months postoperatively were 56.2±6.9 and 82.7±8.2, which were statistically greater than those in the simple reconstruction group (40.2±5.6 and 62.9±8.0), while there was no statistically significant difference between the two groups at 6, 12, and 24 months postoperatively ( P>0.05). The LHB scores of the combined treatment group at 6 and 12 months postoperatively were 70.1±5.4 and 86.1±4.6, which were statistically greater than those of the simple reconstruction group (60.2±4.2 and 70.2±5.8), with statistically significant differences ( P<0.05), while there was no statistically significant difference between the two groups at 24 months postoperatively ( P>0.05). Conclusion:Arthroscopic LHBT insertion reconstruction combined with pulley system repair can relieve early postoperative shoulder pain and improve early function. It is an effective method for the treatment of pulley system injury.
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The anterior cruciate ligament (ACL) injury is a common sports injury that has a significant impact on knee function and patients′ mobility. With the popularity of national fitness campaign in China, the incidence of ACL injury is increasing year by year. Currently, there still lacks clinical standards or guidelines on how to choose appropriate treatment methods, surgical plans and rehabilitation protocols for ACL injury. In order to timely reflect the new treatment concept of ACL injury, standardize its diagnosis and treatment and improve the curative effect, the Sports Medicine Society of Chinese Research Hospital Association and the Editorial Board of Chinese Journal of Trauma organized domestic orthopedic and sports medicine experts to formulate the "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)" based on the level of evidence-based medicine and in compliance with the principle of scientificity, practicability and advancement. The present guideline includes 12 recommendations for the diagnosis, treatment and rehabilitation of ACL injury in order to provide guidance and assistance for the clinical diagnosis and treatment of ACL injury in China.
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The role of multidisciplinary collaborative diagnosis and treatment (MDT) in improving the prognosis of colorectal cancer, lung cancer, breast cancer and other tumors has been proven, but the research of oral cancer MDT is still in the exploratory stage and has not formed a complete conceptual system and operating mode. Oral squamous cell carcinoma (OSCC) is one of the main malignant tumors of the head and neck, with a 5-year survival rate of less than 50%. This article mainly elaborates on the difficulties of oral cancer treatment, the advantages of MDT, and the progress of oral cancer MDT.
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Objective:To investigate the effects of rituximab on lymphocytes and immunoglobulin in the treatment of focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD).Methods:The subjects were FSGS and MCD patients admitted to Ruijin Hospital affiliated to Shanghai Jiaotong University on July 1, 2014 and July 1, 2019. All the enrolled patients were confirmed by clinical examination and renal biopsy, and received rituximab treatment (4 infusions of 375 mg/m 2 with the interval of 7-14 d). The levels of immunoglobulin IgA, IgG, IgM, and lymphocytes of CD19 +, CD20 +, CD3 +, CD3 +CD4 +, CD3 +CD8 + and natural killer cells (CD56 +CD16 +) were compared between baseline and the third month, the sixth month, the ninth month and the twelfth month after treatment. Results:Ninety-six patients with FSGS or MCD were enrolled in this study. The midian age was 28 years old (14-77 years old). The ratio of men to woman was 1.8∶1. There were 65 cases of MCD and 31 cases of FSGS. After rituximab treatment, the 24 h-proteinuria was significantly lower than that before treatment, and the serum albumin level was increased (both P<0.05). After rituximab treatment of 3 months, 6 months, 9 months and 12 months, CD19 + and CD20 + lymphocyte counts were significantly decreased (all P<0.01), and gradually recovered after 6 months. Compared with baseline, at 3, 6, 9, 12 months after rituximab treatment, the level of blood IgG was significantly increased ( P=0.004,<0.001,<0.001,<0.001, respectively), and the level of blood IgM was significantly decreased ( P<0.001, =0.008, =0.005,<0.001, respectively) but the median level still within the normal range (400-3 450 mg/L). The level of blood IgA was not significantly changed (all P<0.05). T lymphocytes (CD3 +, CD3 +CD4 + and CD3 +CD8 +) and natural killer cells (CD56 +CD16 +) showed no significant difference from baseline (all P>0.05). Conclusions:Rituximab can effectively eliminate CD19 + and CD20 + lymphocytes, and has little influence on peripheral blood lymphocyte count and immunoglobulin level except CD19 + and CD20 + lymphocytes. The standard administration of rituximab is safe for patients with FSGS and MCD.
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Objective: To observe the clinical effect of transcatheter direct thrombolysis in treatment of acute upper extremity arterial embolism (AUEAE). Methods: Eighteen patients with AUEAE (18 limbs) were treated with transcatheter direct thrombolysis, and anticoagulation was performed regularly after operation. The treatment effect and complications were observed. Results: The technical successful rate of transcatheter direct thrombolysis was 100% (18/18). After thrombolytic therapy, the symptoms and signs improved, 15 patients (15/18, 83. 33%) were cured, 2 (2/18, 11.11%) became fine and 1 was generally accepted (1/18, 5.56%). The operation time of transcatheter direct thrombolysis was 36-84 (58.83±12.28)h. During the anticoagulation therapy, thrombocytopenia more than 50% occurred in 1 patient. After operation, puncture site hematoma and puncture site femoral artery pseudoaneurysm were observed in 3 cases and 1 case, respectively, and renal function decline occurred in 1 patient, all were alleviated or cured after corresponding treatment. Conclusion: The short-term efficacy and safety of transcatheter direct thrombolysis were both good for treating AUEAE.
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OBJECTIVE：To investigate th e effects of juglone on brain tissu e of rats and its relationship with the biomarkers related to brain tissue injury. METHODS ：Totally 40 rats were divided into blank group ，juglone high-dose ，medium-dose and low-dose groups （34.832，17.416，8.708 mg/kg），with 10 rats in each group. They were given medicine intragastrically once a day ， for consecutive 4 weeks.After last administration ，the general behavior ，brain index and brain tissue morphology were investigated. UPLC-MRM-MS method was used to determine the serum contents of L-dopa（L-Dopa），L-tyrosine（L-Tyr）and L-tryptophan（L-Trp） in rats. The chromatographic condition included Waters Acquity UPLC BEH C 18 column，mobile phase consisted of ammonium acetate aqueous solution-acetonitrile ，gradient elution ，at the flow rate of 0.3 mL/min，sample size of 5 μL，column temperature of 30 ℃；MS condition include electrospray ion source ，in positive ion mode ，capillary voltage of 3 500 V，desolvent gas flow of 650 L/h，desolvent temperature of 350 ℃，ion source temperature of 110 ℃. RESULTS ：Compared with blank group ，the rats in each dose group showed the behavior of tiredness and weakness of limbs. The brain tissue morphology showed pathological changes ， which contained blood vessel congestion in the cerebral and cerebellar cortex ，partial cell nucleus pyknosis in the pyramidal cell layer，deep staining of nuclei ，irregular shape and unclear boundary and other pathological changes ；the brain index of juglone high-dose group increased significantly （P＜0.05）. The established UPLC-MRM-MS method showed good specificity and the range of L-Dopa，L-Tyr and L-Trp were 31.25-32 000，31.25-32 000，15.625-16 000 ng/mL（r＝0.999 1-0.999 9），respectively. The limits of detection were 6.250，5.625，3.125 ng/mL，respectively. The limits of quantitation were 15.625，18.75，10.00 ng/mL，respectively. RSDs of precision ，accuracy and stability （24 h）tests were all Matrix effects were 95.1％-100.1％ （RSD are not more than 3.25％，n＝3）. Compared with blank group，the contents of L-Dopa were increased significantly injuglone medium-dose and high-dose groups （P＜0.01）. The contents of L-Tyr were increased significantly in juglone lowdose，medium-dose and high-dose gro ups，while the contents of L-Trp were decreased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS ：Juglone has an effect on the general behavior，brain index and brain tissue morphology of rats. It may affect the brain function of rats by increasing the contents of L-Dopa and L-Tyr in serum and decreasing the contents of L-Trp.
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Objective:To investigate the finite element analysis and early-stage clinical effects of double bundle anterior cruciate ligament (ACL) reconstruction with femoral direct fiber insertion.Methods:From June 2016 to June 2017, a total of 26 cases of ACL reconstruction were analyzed retrospectively, including 15 males and 11 females, mean age 30.5±4.6 years. All the patients underwent ACL reconstruction by the same operator. The early-stage clinical effects were evaluated by the finite element analysis, pivot shift test, Lachman test, preoperative and postoperative IKDC score, Lyshlom score, KT-2000, 3D-CT and MRI.Results:The finite element analysis confirmed theoretically that the double bundle ACL reconstruction with femoral direct fiber insertion could restore the stability and biomechanics of knee effectively. The results of pivot shift test were negative, and the Lachman test were negative except one first-stage positive after operation. 3D-CT showed that the bone tunnel was located in the direct fiber area. MRI showed clearly the ACL of double bundle after operation. Lysholm score increased from 56.5±3.6 pre-operation to 61.9±3.2 at three months after operation, and up to 88.5±2.0 two years after operation with statistically significant difference ( F=824.72, P<0.001). IKDC score increased from 48.3±2.8 before operation to 58.0±2.0 at three months after operation, and to 92.5±2.6 at two years after operation with statistically significant difference ( F=2 256.66, P<0.001). KT-2000 side-side difference decreased from 5.6±0.7 mm to 1.6±0.5 mm at three months after operation, and to 1.5±0.6 mm at two years after operation with statistically significant difference ( F=389.14, P<0.001). Conclusion:The double bundle ACL reconstruction with femoral direct fiber insertion can effectively restore the stability and the biomechanical environment of knee joint with satisfied early-stage clinical effects.
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Objective To explore the characteristics of diagnosis and treatment of acupuncture and moxibustion for heel pain.Methods We searched the literatures related to heel pain treated by acupuncture and moxibustion in CNKI,WFPD,VIE CBM,PubMed and Embase,then summarized the intervene measures related to acupuncture and moxibustion,clinical characteristics of syndrome differentiation and acupuncture points selection method,frequency,treatment course,treatment effect,follow-up outcomes and safety.Results A total of 47 articles are included in the acupuncture treatment of heel pain commonly used measures like small needling knife,acupuncture,acupoint injection,electro-acupuncture,fire needling,warm needling and moxibustion.The percentage of article involved in treating heel pain by small needling knife was 55.32％ (26/47) and 21.28％ (10/47) by acupuncture.The percentage of articles involved in acupuncture points selection method by differentiation of disease was 93.62％ (44/47).The main acupuncture points in the 47 articles was ashi acpoint (68.09％,32/47).The therapy frequency and treatment courses varied from the differences of the acupuncture and moxibustion methods.For small needling knife,the percentage of treating frequency of one time was 36.17％ (17/47) and evaluating the curative effect after one treatment was 40.43％ (19/47).For acupuncture,the percentage of treating frequency of once a day was 17.02％ (8/47) and 23.40％ (ll/47).The effective rate showed a lot of variation from 69.56％-100％ vary by intervene measures.The follow-up rate was not high,only 27.66％ (13/47).There was only one literature referring to the adverse reaction.Conclusions The literatures review showed that the small needling knife was the most frequent method,followed by acupuncture.Acupuncture points selection by disease differentiation is the common method.The main acupuncture points applied in heel pain is ashi acupoint.Evaluating the effect after one treatment was common used for small needling knife.Once a day and ten times a therapy course were the common treatment frequency and treatment course for the remaining intervene measures.Acupuncture and moxibustion could show immediate and probable long-term positive effect for heel pain without no severe adverse reactions.
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OBJECTIVE： To identify chemical components of Forsythia suspense. METHODS： UPLC-Q-TOF-MS technology was used for the chemical components analysis of F. suspense. The determination was performed on ACQUITY UPLC BEH C18 column with mobile phase consisted of 0.1％ formic acid aqueous solution （A）- 0.1％ formic acid acetonitrile solution （B） with gradient elution， at the flow rate of 0.3 mL/min； the column temperature was set at 30 ℃； the sample size was 5 μL. Positive and negative ions were detected by electrospray ionization. The temperature of the ion source was 550 ℃； the atomizing gas was N2； the atomizing gas and the auxiliary pressure were 379.2 kPa； the air curtain pressure was 241.3 kPa； the decluster voltage was 80 V/－80 V； the collision energy was 35 eV/－35 eV； the mass scanning range was 80-1 500 Da. Peakview 2.0 software was used to screen the target components by the first-order mass spectrometry， and calculate the high-resolution and accurate molecular weight of each component， compare with the reference spectrum and related literature， or calculate the elemental composition of fragment ions in the second-order mass spectrometry， analyze their decomposition pathways， then infer the structure of compounds. RESULTS & CONCLUSIONS： 45 kinds of compounds were identified from F. suspense，which included 7 phenylethanol glycosides，5 lignans，5 terpenes， 12 flavonoids，7 organic acids，2 phenols，2 quinones，2 glycosides and 3 other components. There were 19 compounds identified for the first time in F. suspense. The study provides a reference for the in-depth study of the pharmacodynamic substance basis of F. suspense and the rapid qualitative and quantitative analysis of the components.
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OBJECTIVE： To analyze chemical components as coumarin in Saposhnikovia divaricata， and to provide reference for comprehensive analysis of pharmacodynamic material base in S. divaricata. METHODS： UPLC-Q-TOF-MS method was adopted. Chromatographic condition： the determination was performed on ACQUITY UPLC BEH C18 column with mobile phase consisted of 0.1％ formic acid water-0.1％ formic acid acetonitrile （gradient elution） at the flow rate of 0.3 mL/min. The column temperature was 35 ℃， and sample size was 3 μL. MS condition： ESI， in positive and negative ion mode， ESI+/ESI－ 5 500 V/－4 500 V， declustering potential of 80-－80 V， auxiliary heating gas pressure of 55.00 psi， atomizing gas pressure of －55 psi， curtain gas pressure of －35.00 psi， desolvent temperature of 550 ℃， collision activation scanning energy of 15 eV， collision voltage of 35 psi. Component analysis was performed by comparing with the related literature data and the standard chromatogram control combined with accurate relative molecular mass of compounds provided by UPLC-Q-TOF-MS. RESULTS： Totally 135 chemical components were analyzed in ESI+ mode， and the 105 chemical components were analyzed in ESI－ mode. 11 chemical components as coumarin were identified in ESI+ mode， such as isoimperatorin， umbelliferone， scopolamine， xanthotoxin， psoralen， Ostenol， fraxidin， isoimperatorin， 5-hydroxyl-8-methoxypsoralen， phellopterin， decursin. CONCLUSIONS： The method is accurate and rapid， and can be used for the analysis of chemical components as coumarin in S. divaricata.
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OBJECTIVE： To investigate the analgesic and anti-inflammatory effects of ethanol extract from Arenga pinnata in mice/rats after intragastric administration. METHODS： The mice were randomly divided into A. pinnata ethanol extract group and solvent control group （distilled water）， with 20 mice in each group. Maximal dosage method was used to observe the acute toxicity of ethanol extract from A. pinnata with intragastric administration. The mice were randomly divided into A. pinnata ethanol extract high-dose， medium-dose and low-dose groups [6.5， 3.25， 1.625 g/kg （by ethanol extract， similarly here in after）， i.g.]， positive control group （0.005 g/kg morphine， i.p.） and blank control group （distilled water， i.g.）. The analgesic effect was evaluated by hot plate method， and the licking latency was compared 30， 60 and 90 minutes after administration. The mice were randomly divided into A. pinnata ethanol extract high-dose， medium-dose and low-dose groups （6.5， 3.25， 1.625 g/kg， i.g.）， positive control group （loxoprofen sodium 0.023 g/kg， i.g.） and model control group （distilled water， i.g.）. The analgesic effect was evaluated by acetic acid writhing method. The writhing times within 20 minutes were compared and the writhing inhibition rate was calculated. The mice were randomly divided into A. pinnata ethanol extract high-dose， medium-dose and low-dose groups （6.5， 3.25， 1.625 g/kg， i.g.）， positive control group （morphine 0.005 g/kg， i.p.）， model control group （distilled water， i.g.）. The analgesic effect was evaluated by formalin-induced pain method. The total licking time was compared between 0-5 min and 10-40 min after formalin administration； the inhibition rate of licking was calculated. The mice were grouped according to acetic acid writhing test. The mice were given relevant medicine once a day for consecutive 3 days. The mice were given xylene to induce inflammation model， and the degree of ear swelling was compared. Rats were randomly divided into A. pinnata ethanol extract high-dose， medium-dose and low-dose groups （4.5， 2.25， 1.125 g/kg， i.g.）， positive control group （losoprofen sodium 0.016 g/kg， i.g.）， model control group （distilled water， i.g.） and blank control group （distilled water， i.g.）， once a day， for consecutive 3 days. The rats were given Freund’s complete adjuvant to induce inflammation model and then given relevant medicine for consecutive 7 d. The degree of paw swelling was compared before inflammation and within 7 days after inflammation. The number of mice/rats in each group was 8 to 14 in the analgesic and anti-inflammatory tests. RESULTS： Compared with solvent control group， the body weight of mice had no significant increase in A. pinnata ethanol extract group； no drug-induced toxicity was found. Compared with blank control group， licking latency in mice was significantly prolonged in A. pinnata ethanol extract high-dose group 30 and 60 minutes after medication （P＜0.01）. Compared with model control group， the times of writhing， total licking time and the degree of ear swelling of mice were decreased significantly in A. pinnata ethanol extract high-dose， medium-dose and low-dose groups （P＜0.05 or P＜0.01）. Compared with model control group， the degree of paw swelling began decrease significantly in A. pinnata ethanol extract high-dose group 4 h after inducing inflammation， and the effect lacted until the 7th day （P＜0.01）. CONCLUSIONS： A. pinnata ethanol extract has no significant acute oral toxicity， and possesses significant analgesic and anti-inflammatory effects.
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Objective To investigate the incidence and clinical features of women with hypertension disorders of pregnancy complicated with renal impairment at high altitude,and explore the impact of proteinuria,renal insufficiency and preexisting chronic kidney disease (CKD) on these patients.Methods A pool of 1790 pregnant women admitted to Yunnan Diqing Tibetan Autonomous Prefecture People's Hospital from September 2017 to September 2018.Data of 123 patients who met the criteria of hypertension disorders in pregnancy were collected and retrospectively studied.Their clinical characteristics and pregnancy outcomes were analyzed.Patients with hypertension and renal impairment,simple hypertension patients as well as normal pregnant women were compared.Hypertensive patients with proteinuria,renal insufficiency (Scr ＞ 70 μmol/L) and preexisting CKD were also compared with simple hypertension patients.The impact of proteinuria,renal insufficiency and preexisting CKD on patients with hypertension disorders of pregnancy was assessed by multivariate logistic analysis.Results Of these 123 patients,61 cases (49.6％) had renal impairment,57 cases (46.3％) had proteinuria,15 cases (12.2％)had renal insufficiency and 6 cases (4.9％) had preexisting CKD.Compared with normal pregnant women and simple hypertension patients,patients with hypertension and renal impairment had higher blood pressure,Scr,primipara rate and caesarean section rate (all P ＜ 0.05),lower gestational age,neonatal Apgar scores and plasma albumin level (all P ＜ 0.05),as well as adverse pregnancy outcomes,including premature birth,stillbirth/neonatal death,intrauterine growth restriction,infants of low-birth weight and admission to the neonatal intensive care unit (NICU) (all P ＜ 0.05).The clinical features and pregnancy outcomes of 57 patients with proteinuria correlated with the proteinuria.Compared with non-nephrotic syndrome patients and patients without proteinuria,patients with nephrotic syndrome (NS) had lower plasma albumin level and higher rates of premature birth,infants of low-birth weight and admission to NICU (all P ＜ 0.05).Among 15 patients with renal insufficiency,there were 13 mild abnormal cases (70 μmol/L ＜ Scr≤ 123 μmol/L,86.7％).Compared with those with normal renal function,patients with renal insufficiency had higher Scr,uric acid and rates of preeclampsia/eclampsia,intrauterine growth restriction,infants of low-birth weight and admission to NICU,while lower plasma albumin level (all P ＜ 0.05).Among 6 patients with preexisting CKD,4 had NS,2 had renal insufficiency,5 delivered before 37 weeks,and 2 infants died.Logistic regression analysis showed that NS (0R=4.863,P=0.032),renal insufficiency (OR=7.550,P=0.017) and systolic pressure (OR=1.061,P=0.002) were independent risk factors for adverse pregnancy outcomes among patients with hypertension disorders in pregnancy.Conclusions Renal impairment is common among patients with hypertension disorders in pregnancy at high altitude and has adverse effects on pregnancy outcomes.Massive proteinuria,renal insufficiency and systolic pressure are risk factors for these patients.
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Objective To investigate the early stage clinical outcomes of reconstruction of the anterior cruciate ligament with functional eccentric fixation. Methods We retrospective reviewed the 35 patients with anterior cruciate ligament reconstruc?tion from autologous hamstring tendon from April 2015 to March 2017. The humeral were fixed with interference screws and divid?ed into two groups according to different fixation methods. The group I was fixed with functional eccentric interference screw, in?cluding a total of 16 cases (9 males and 7 females, mean age 26.8 years). The group II was fixed with anatomical foot print central fixation screw, including a total of 19 cases (11 males and 8 female, mean age 27.6 years). Lysholm scores were recorded before and 1 year postoperatively in group I and group II. Gait analysis of knee flexion and extension, varus and valgus, internal and exter?nal rotation angle, and the MRI was performed at 1 year after surgery to observe the clinical effects. Results The Lysholm score of the functional eccentric fixed group increased from preoperative 58.5±5.5 points to 87.5±4.5 points with statistically significant difference (t=18.532, P=0.014). The foot print central fixed group increased from preoperative 57.0±6.5 points to 89.0±5.0 points with statistically significant difference (t=19.213, P=0.012). There was no significant difference between the eccentric fixed group and the foot print central fixed group in postoperative function (t=0.968, P=0.067). In gait analysis, the maximum flexion angle of the knee joint was increased from 51.8°±4.5°to 61.4°±3.5°before operation in functional eccentric group (t=8.532, P<0.001). The average mid?standing angle in eccentricity group (3.8°±2.1°) was lower than that in the foot center group (8.5°±2.8°) (t=8.716, P<0.001). There was no significant difference in the angle of internal and external valgus between the functional eccentricity group (8.6°±5.8°) and the fixed position of the foot print group (5.4°±5.2°) (t=0.382, P=0.844). The average mid?standing external rota? tion angle of the functional eccentric group was reduced from preoperative 10.5°±6.8°to postoperative-2.3°±4.1°(t=7.987, P<0.001). There was no significant difference in the average mid?standing external rotation angle of the standing phase in the postop?erative functional eccentricity group (-2.3°±4.1°) comparing with that of the foot center group (-2.1°±4.8°) (t=0.628, P=0.581). Conclusion Arthroscopic reconstruction of ACL with functional eccentric can effectively restore the function and kinematic char?acteristics of the knee joint.
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Objective@#To investigate the current status of malaria rapid diagnostic test (RDT) strips application and malaria laboratory technicians' evaluation about them at primary healthcare provider level in Jiangsu Province.@*Methods@#From November to December 2016, 878 medical institutions and 118 CDCs of city, county and township/community level in Jiangsu Province were selected as study samples using stratified random sampling method. Self-designed questionnaire was distributed to investigate the institution's malaria work task, RDT strips application and evaluation status in 2015. We also investigated the socio-demographic information and collected the RDT strips evaluation score from the malaria laboratory technicians selected from the institutions investigated (one technician from each institution). Rank sum test was performed to compare the RDT strips evaluation scores between medical institutions and CDCs, and among different medical institutions and CDCs.@*Results@#In 2015, 405 cases of malaria were reported, 362 200 person-time of malaria blood testing task was conducted, and 100 000 RDT strips were procured and provided for healthcare providers in Jiangsu province for free. Of the 996 healthcare institutions investigated, 628 used RDT strips in the year 2015 and the median (P25, P75) of RDT strips volume used in these institutions was 10 (2, 25). The volume of RDT strips used in CDCs (15 (5, 52)) was significantly higher than that in medical institutions (10 (2, 25), (Z=3.42, P=0.001)). The investigated CDCs gave higher score on RDT strips' testing time per operation (10 (8.5, 10)) than medical institutions (9(8, 10), (Z=-2.20, P=0.028)). The employers of 614 investigated malaria laboratory technicians used RDT strips in 2015. The median of the scores given by CDC malaria laboratory technicians for RDT strips in terms of testing time per operation, testing operation and results judgement difficulties were 10 (9, 10), 10 (9, 10) and 10 (9, 10), respectively, which were significantly higher than those from technicians of medical institutions (9 (8, 10), 9 (8, 10), 9 (8, 10), (Z values were -2.55, -2.97 and -2.96, respectively; P values were all less than 0.05)).@*Conclusion@#RDT strips had been widely performed in health institutions in Jiangsu Province. The amount of RDT strips used in CDCs was significantly higher than that in medical institutions. Primary-level institutions and malaria laboratory technicians generally recognized RDT strips' advantage for application in terms of testing time and operational procedure. CDCs and malaria laboratory technicians from them gave higher regards on RDT strips in terms of testing time per operation, testing operation and results judgement difficulties compared with that of medical institutions.
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Objective To explore the effects of C/EBPα knockout in podocyte on diabetic nephropathy and its mechanisms.Methods C/EBPαloxp/loxp mice were crossed with podocin-cre mice to obtain F1 hybrids and then propagated until homozygous mice (C/EBPαf/f) were obtained.Diabetic nephropathy (DN) models were established by low-dose streptozotocin (STZ,100 mg/kg) administration after 25 weeks of normal diet or 45％ high-fat diet treatment,and biochemical indicators of blood and urea were measured.The morphological characteristics and the proteins regulating oxidative stress and mitochondrial function were detected.Results The type 2 DN models were successfully constructed based on transgenic mice.The kidneys of 8-month-old C/EBPαf/f mice did not show obvious morphological changes,but after constructing DN models,they showed obvious renal impairment,inflammation and oxidative stress.Compared with wild-type DN mice,the protein levels of nephrin and E-cadherin in DN C/EBPαf/f mice with DN were significantly decreased (P ＜ 0.01);fibronectin and Nrf2 protein levels were all increased (all P ＜ 0.05).Keap1,phospho-AMPK and mitochondrial function related genes Pgc-1α protein levels were all decreased (all P ＜ 0.05).Conclusion Podocyte C/EBPα knockout exacerbates diabetic nephropathy by promoting fibrosis and inhibiting Pgc-1α-mediated mitochondrial antioxidant function.
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Objective To understand the situation related to health seeking and diagnosis of imported malaria and to provide practical measures for malaria elimination in Jiangsu province.Methods Data on imported malaria cases in Jiangsu province was retrieved in CISDCP from 2014 to 2016.Relevant information on health seeking behavior,diagnosis and treatment of the disease was gathered.Results A total of 1 068 imported cases were reported in Jiangsu province from 2014 to 2016.Except for one malaria case that was caused by blood transfusion,the rest patients were all recognized as'imported'.Majority of the cases were migrant laborers working in African countries.The accurate rates on the diagnosis of ovale,vivax and quartan malaria and mixed infection were relatively low,as 79.3％ (107/135),29.5％ (18/61),52.9％ (18/34) and 0.0％ (0/2) at the primary health care settings,respectively.Rate of seeking health care on the same day of onset was more in 2015 than in 2014 and 2016 (X2=18.6,P=0.001).While only 65.4％ (699/1 068) of the patients were diagnosed correctly at the primary health care settings.There appeared no statistical difference in the 3-year-study period (x2=5.4,P=0.246).Capacity on'correct diagnosis' seemed stronger at the CDC than at the hospital levels (x2=13.2,P=0.000;x2=5.4,P=0.020).Totally,72.7％ (32/44) of the severe falciparum malaria cases did not immediately seek for health care when the symptoms started.Conclusions Migrant workers returning from the high endemic malaria areas seemed to have poor awareness in seeking health care services.Capability on correct diagnosis for malaria at the primary health care settings remained unsatisfactory and staff from these settings needs to receive adequate training.
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Objective To understand the situation related to health seeking and diagnosis of imported malaria and to provide practical measures for malaria elimination in Jiangsu province.Methods Data on imported malaria cases in Jiangsu province was retrieved in CISDCP from 2014 to 2016.Relevant information on health seeking behavior,diagnosis and treatment of the disease was gathered.Results A total of 1 068 imported cases were reported in Jiangsu province from 2014 to 2016.Except for one malaria case that was caused by blood transfusion,the rest patients were all recognized as'imported'.Majority of the cases were migrant laborers working in African countries.The accurate rates on the diagnosis of ovale,vivax and quartan malaria and mixed infection were relatively low,as 79.3％ (107/135),29.5％ (18/61),52.9％ (18/34) and 0.0％ (0/2) at the primary health care settings,respectively.Rate of seeking health care on the same day of onset was more in 2015 than in 2014 and 2016 (X2=18.6,P=0.001).While only 65.4％ (699/1 068) of the patients were diagnosed correctly at the primary health care settings.There appeared no statistical difference in the 3-year-study period (x2=5.4,P=0.246).Capacity on'correct diagnosis' seemed stronger at the CDC than at the hospital levels (x2=13.2,P=0.000;x2=5.4,P=0.020).Totally,72.7％ (32/44) of the severe falciparum malaria cases did not immediately seek for health care when the symptoms started.Conclusions Migrant workers returning from the high endemic malaria areas seemed to have poor awareness in seeking health care services.Capability on correct diagnosis for malaria at the primary health care settings remained unsatisfactory and staff from these settings needs to receive adequate training.
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<p><b>OBJECTIVE</b>To explore the protective effect and possible mechanism of electroacupuncture (EA) pretreatment at "Zhongliao" (BL 33) and "Tianshu" (ST 25) on ovarian in rats with premature ovarian insufficiency (POI).</p><p><b>METHODS</b>A total of 32 SD female rats with regular estrus were randomly divided into a blank group, a model group, an EA group and an immobilization group, 8 rats in each one. The rats in the model group, EA group and immobilization group were treated with intraperitoneal injection of 4-vinylcyclohexene diepoxide (160 mg/kg) for 15 days to establish the model. From the beginning of model establishment, the rats in the EA group were treated with EA pretreatment at "Zhongliao" (BL 33) and "Tianshu" (ST 25), once a day for the first two weeks (5 treatments per week) and once every two days for the last two weeks (3 treatments per week). EA was given 20 min per treatment for four weeks. The rats in the immobilization group were treated with immobilization with identical duration, frequency and total amount as the EA group. No treatment was given in the blank group and model group. When model was successfully established in the model group, rats were sacrificed to test the weight of sexual gland and the sexual gland index; the ELISA method was applied to test the level of anti-müllerian hormone (AMH) and inhibin B; the radioimmunoassay method was applied to test the level of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E), progesterone (P) and testosterone (T). In addition, the morphology and the number of ovarian follicles were observed; and western blot method was applied to test the expression of B-cell lymphoma-2 (Bcl-2) and Bcl-2-associated X protein (Bax) in ovarian tissue.</p><p><b>RESULTS</b>Compared with the blank group, the bilateral ovary weight, ovary index, uterus weight and uterus index decreased (<0.05, <0.01); serum AMH, inhibin B, E and P reduced, while serum FSH, LH and T increased in the model group (all <0.01); primordial follicles and primary follicles decreased, while atretic follicles increased in the model group (all <0.01); the expression of Bax protein increased, while the expression of Bcl-2 protein decreased in the model group (both <0.01). Compared with the model group, the bilateral ovary weight, ovary index and uterus weight increased (<0.05, <0.01); serum AMH, inhibin B, E and P increased, while serum FSH and LH reduced (<0.05, <0.01); primordial follicles and primary follicles increased, while atretic follicles reduced (<0.05, <0.01); the expression of Bax protein reduced, while the expression of Bcl-2 protein increased in the EA group (<0.05, <0.01). The differences of each outcome indexes were not significant between the model group and immobilization group (all >0.05).</p><p><b>CONCLUSION</b>EA pretreatment at "Zhongliao" (BL 33) and Tianshu (ST 25) for 4 weeks has certain protective effect on ovarian in POI rats, which is likely to be related with up-regulating ovarian granular cells, inhabiting the expression of Bcl-2 protein and down-regulating the expression of Bax protein.</p>
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Animals , Female , Rats , Acupuncture Points , Electroacupuncture , Primary Ovarian Insufficiency , Therapeutics , Random Allocation , Rats, Sprague-DawleyABSTRACT
ISO 14708-3 "Implants for surgery-active implantable medical devices-Part 3:implantable neurostimulators" 2017 version and 2008 version are compared, and changes in the standard are interpreted combined with the characteristics of the neurostimulator. The new version of the standard for the first time in the introduction mentioned a new type of non-electrode or extension's neurostimulator. Key issues that have significant impact on safety concerns such as wireless charging temperature rise, MRI acceptance criteria, etc., are given for the first time in the new version. New requirements to the wireless communication section are added, and the electromagnetic compatibility part is greatly adjusted. With more miniature non-electrode or extension's neurostimulator entering the market, standards such as electromagnetic compatibility and MRI, there will be greater adjustments.